Comparison of the effect of Sacubitril /Valsartan with Losartan and Captopril in improving right ventricular function in patients with right heart failure, a randomized clinical controlled trial

Background: There is evidence supporting the efficacy of Sacubitril /Valsartan for improving left heart failure, but few studies have examined its effects on right ventricular (RV) dysfunction. The current study aimed to investigate the effects of Sacubitril /Valsartan on RV dysfunction in patients with right heart failure. Methods: The current study was a randomized and parallel clinical trial study. Patients over 18 years with any degree of right heart failure regardless of Left ventricular ejection fraction (LVEF) were included. The included patients were assigned randomly to three study arms using simple random allocation, i.e. the intervention group (Sacubitril Valsartan recipients) and the control groups (Losartan and Captopril recipients). The SPSS software version 19 was used for data analysis. Results: The changes in LVEF, RV FAC, RV diameter, DOE grade, and TAPSE in the Sacubitril/Valsartan group were significantly higher than the other two groups. The severity of RV dysfunction, as well as  TR (Tricuspid Regurgitation) severity, decreased significantly three months after the intervention compared to the beginning of the intervention in all groups especially in the Sacubitril/Valsartan group (p: 0.006). The mortality rate in the Sacubitril/Valsartan, Losartan, and Captopril groups, were 2(6.7%), 2(11.2%), and 1(7.7%) respectively (p: 0.83). Also, 27.6, 62.5, and 7.7% of cases in the Sacubitril/Valsartan, Losartan, and Captopril reached to optimum dose (p: 0.006). Conclusion: Considering the results, it seems that Sacubitril/Valsartan has a positive effect on improving RV dysfunction in patients with right heart disorders

Eosinophilic Granulomatosis With Polyangiitis Presenting With Visual Problems and Subendocardial Fibrosis, A Case Report

ABSTRACT This case highlights the atypical presentation of eosinophilic granulomatosis with polyangiitis (EGPA) with neurological and cardiac complications, emphasizing the necessity of early recognition and aggressive treatment to prevent morbidity and mortality

Evaluation of genes and molecular pathways involved in the development of cardiovascular disease in preeclampsia patients: biological system and bioinformatics analysis approach

Abstract Background: Hypertension in preeclampsia (PE) is one of the most important complications in these patients, which increases the risk of cardiovascular disease (CVD). Bioinformatics analysis can identify the signaling pathways, genes and microRNAs involved in the development of CVD due to hypertension; it can also reduce the risk of developing PE by providing appropriate target therapies.Method: In this study, after collecting data and determining the gene list, changes in gene expression in patients with severe and non-severe forms of PE were compared. Protein-Protein interaction (PPI) and pathway enrichment analysis were also used to evaluate the common genes and pathways between the two cited forms of PE. Result: FGF, TNF, Adherent junction, metabolic signaling pathway, GATA3-mediated activation pathways of Th2, EGF / EGFR signaling pathway and Rab GTPase among the most important signaling pathways are effective in CVD development. HLTF, SUMO1, KDR, SNRPD3, DERL2, VCP, EIF4B, NOTCH1, SOCS3, CBL, ICAM-1, ITGB2, STRN, MEF2A and PTPRC are the most important genes and miR-3135-3P, miR-505, miR-6088, miR-451, miR-4637-3P, miR-1281-3P, miR-4304-3P, miR-323-3P, miR-3150-3p.1, miR-4718, miR-151-5p, miR-3117-5p.2, miR-3613, miR-1278- 3P, miR-4467, miR-4730 , miR-190b-3p , miR-610-5p, miR-3648-3p , miR-4796-3p, miR-2277-3P, miR-325, miR- 6807-3p , miR-551a-3p, and miR-3131-3P have been also effective in the development of CVD by hypertension in PE patients. Conclusion: Finally, it was concluded that identification of common signaling pathways, genes and microRNAs between severe and non-severe forms of PE can be effective to design preventive and treatment strategies for CVD caused by hypertension.</jats:p

Early Detection of Subclinical Left Ventricular Dysfunction in Patients with Systemic Lupus Erythematosus: A Case-Control Study

Background: The aim of this study was to evaluate subclinical left ventricular (LV) dysfunction by two-dimensional (2D) speckle tracking echocardiography (STE) and three-dimensional echocardiography in patients with systematic lupus erythematosus (SLE). Methods: This case-control study was performed on 106 patients, divided into the two groups of case (53 patients with SLE) and control (53 healthy individuals). All study participants were evaluated by transthoracic echocardiography, as well as Tissue Doppler echocardiography. Accordingly, ventricular dimensions and LV ejection fraction (LVEF) were assessed. Moreover, E velocity, A velocity, E/A ratio, and E/E’ ratio were evaluated in both groups. The LV global longitudinal strain (GLS) was measured by 2D STE in all individuals. Results: There was no significant difference between the two study groups regarding LVEF based on traditional echocardiography. However, E velocity, A velocity, and the E/e’ ratio were higher in the SLE patients (P &lt; 0.05). In addition, the anti-double-stranded DNA (anti-dsDNA) positivity in SLE patients was associated with the lower levels of LVEF. No significant correlation was found between disease duration, LVEF, and LV GLS (P &gt; 0.05). Conclusions: Detection of subclinical LV systolic dysfunction by GLS is possible in SLE patients despite normal LVEF in traditional echocardiography. Therefore, LV could be used for the early detection and prevention of cardiac involvement in SLE patients.</jats:p

The Presence of Patent Foramen Ovale in the Superior Type of Sinus Venosus Atrial Septal Defect

Background: The superior type of sinus venosus atrial septal defect (SVASD) is a rare form of the atrial septal defect (ASD) in which the upper part of the atrial septum does not exist. The presence of other cardiac anomalies such as anomalous pulmonary venous connections has been reported in this type of congenital heart disease. This study aimed to assess the presence of the patent foramen ovale (PFO) in patients with the superior type of SVASD.&#x0D; Methods: This retrospective case-control study on 387 patients, consisting of 187 patients with a definite SVASD and 200 patients with problems other than the ASD, was conducted in Rajaie Cardiovascular Medical and Research Center between February 2005 and July 2014. Seven patients with inadequate data were excluded from the analysis. The presence/absence of the PFO was also evaluated in the case and control groups.&#x0D; Results: The analyses were performed on 182 male and 198 female patients at a mean age of 39.07±14.41 and 51.01±15.80 years in the case and control groups, respectively. The PFO was significantly more frequent in the patients with the superior type of SVASD than in those without the condition (P&lt;0.001). The persistence of the left superior vena cava was seen in 34 out of 180 patients with SVASD and in 1 out of 200 patients without the condition (18.9% vs 0.5%; P&lt;0.001).&#x0D; Conclusion: This study was the first to highlight the coexistence of the PFO and the superior type of SVASD. Physiological, genetic, or fetal factors may play an important role in the association between the PFO and the SVASD.</jats:p